Brachiterapia permanente per il tumore localizzato della prostata

Quality of Life questionary for patients with prostate cancer

Below is a list of statements that other people with your illness have said are important.
By circling one (1) number per line, please indicate how true each statement has been for you during the past 7 days

PHYSICAL WELL-BEING		Not at all	A little bit	Some- what	Quite a bit	Very much
GP1	I have a lack of energy	0	1	2	3	4
GP2	I have nausea	0	1	2	3	4
GP3	Because of my physical condiction, I have trouble meeting the needs of my family	0	1	2	3	4
GP4	I have pain	0	1	2	3	4
GP5	I am bothered by side effects of treatment	0	1	2	3	4
GP6	I feel ill	0	1	2	3	4
GP7	I am forced to spend time in bed	0	1	2	3	4


SOCIAL/FAMILY WELL-BEING		Not at all	A little bit	Some- what	Quite a bit	Very much
GS1	I feel close to my friends	0	1	2	3	4
GS2	I get emotional support from my family	0	1	2	3	4
GS3	I get support from my friends	0	1	2	3	4
GS4	My family has accepted my illness	0	1	2	3	4
GS5	I am satisfied with family communication about my illness	0	1	2	3	4
GS6	I feel close to my partner (or the person who is my main support)	0	1	2	3	4
Q1	Regardless of your current level of sexual activity, please answer the following question. If you prefer not answer it, please check this box [ ] and go to the next section
GS7	I am satisfied with my sex life	0	1	2	3	4

By circling one (1) number per line, please indicate how true each statement has been for you during the past 7 days

EMOTIONAL WELL-BEING		Not at all	A little bit	Some- what	Quite a bit	Very much
GE1	I feel sad	0	1	2	3	4
GE2	I am satisfied with how I am coping with my illness	0	1	2	3	4
GE3	I am losing hope in the fight against my illness	0	1	2	3	4
GE4	I feel nervous	0	1	2	3	4
GE5	I worry about dying	0	1	2	3	4
GE6	I worry that my condiction will get worse	0	1	2	3	4

FINCTIONAL WELL-BEING		Not at all	A little bit	Some- what	Quite a bit	Very much
GF1	I am able to work (include work at home)	0	1	2	3	4
GF2	My work (include work at home) is fulfilling	0	1	2	3	4
GF3	I am able to enjoy life	0	1	2	3	4
GF4	I have accepted my illness	0	1	2	3	4
GF5	I am sleeping well	0	1	2	3	4
GF6	I am anjoying the things I usually do for fun	0	1	2	3	4
GF7	I am content with the quality of my life right now	0	1	2	3	4

By circling one (1) number per line, please indicate how true each statement has been for you during the past 7 days

ADDICTIONAL CONCERNS		Not at all	A little bit	Some- what	Quite a bit	Very much
C2	I am losing weight	0	1	2	3	4
C6	I have a good appetite	0	1	2	3	4
P1	I have aches and pains that bother me	0	1	2	3	4
P2	I have certain areas of my body where I experience significant pain	0	1	2	3	4
P3	My pain keeps me from doing things I want to do	0	1	2	3	4
P4	I am satisfied with my present comfort level	0	1	2	3	4
P5	I am able to feel like a man	0	1	2	3	4
P6	I have trouble moving my bowels	0	1	2	3	4
P7	I have difficulty urinating	0	1	2	3	4
BL2	I urinate mare frequently than usual	0	1	2	3	4
P8	My problems with urinating limit my activities	0	1	2	3	4
BL5	I am able to have and maintain an erection	0	1	2	3	4

Carcinoma Prostatico

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